| Dr. Michael Broder <vitreophile2@yahoo.com>
There has been some recent confusion about
different types of
surgical anesthesia. This is a summary of information which I
hope
is helpful. Orthopedic and other surgeons generally work with an
anesthesiologist, a specialist in Perioperative Medicine. This
is
care of a patient prior to, during and after surgery. This
includes
evaluating and preparing a patient to undergo the rigors of
surgery.
The anesthesiologist plans the anesthetic for the patient and
then
cares for the patient during the surgical procedure. He/she
monitors
the patient’s blood pressure, heart rate, breathing, and level
of
consciousness and analgesia. The anesthesiologist adjusts the
anesthetic plan, medications, fluids, and other parameters to
provide
a safe, pain free surgical experience for the patient. He/she
will
take care of your medical needs during the operation so the
surgeon
can concentrate on the surgery. After the surgery, the
anesthesiologist continues to provide the care necessary to
ensure a
smooth emergence from the anesthetic and pain control after your
surgery.
Anesthesiologists are specialists in control of both acute
and chronic pain. They also are involved in the care of
critically
ill patients.
To become an Anesthesiologist requires four years in
college to earn an undergraduate degree, four years of medical
school
to earn a Doctor of Medicine degree. He/she must then complete
another four years of training in an accredited Anesthesia
Residency
Program. The physician may then complete another one or two
years in
a subspecialty of anesthesia such as Obstetrical Anesthesia,
Cardiac
Anesthesia, Pediatric Anesthesia, or Pain Management.
After completing the above training, he or she must then
pass a rigorous written and oral exam. To become a “Diplomat of
the
American Board of Anesthesiology”.
Some anesthesiologists complete similar requirements to
become certified in their subspecialty as well, such as Pain
Management Certification.
In some cases a certified Nurse anesthetist may perform much
of the
monitoring and some other parts of the procedure, under
supervision
of the anesthesiologist. Regulations vary somewhat from state
to
state.
Types of anesthesia:
An-esthesia : lack of sensation
1. Local: An injection in the skin and subcutaneous tissue.
This might be used for a superficial biopsy.
2. Nerve Block : Injection into a nerve sheath to affect an
entire
area served by the nerve. This is a common technique used by
dentists for example. An injection of the dental (mental) nerve
will
result in numbness of the entire mandible (jawbone) on that side
FOR HIP SURGERY, A FEMORAL NERVE BLOCK IS GIVEN. THIS RESULTS IN
DEEP LOSS OF SENSATION IN THAT LEG
SPINAL ANESTHESIA – TWO TYPES
3A EPI-DURAL ANESTHESIA – This is reserved for a more limited
area
where only a few of the exiting spinal nerve roots will be
affected.
A very tiny needle or small plastic catheter is injected into
the
space just outside of the main covering over the spinal nerve
roots
and cord. It is trapped in that area & can not change levels.
3B”Spinal” Sub-Dural Anesthesia – Allows for deeper and more
extensive area of pain control and paralysis. Prevents
uncontrolled
muscle movement (so you don’t kick the surgeon in the head), and
has
other advantages. In the early phase, the anesthetic can move
up
and down the spinal cord with gravity, controlled by positioning
the
patient.
Sometimes, special needles and catheters are used to combine
both
types of spinal anesthesia.
GENERAL ANESTHESIA:
This usually refers to the use of an endo-tracheal tube,
Anesthetic
gases and is reserved as back up for other techniques, use in
people
with respiratory, cardiac and certain other high risk
situations.
SEDATION:
This refers to a variety of techniques using various intravenous
medications.
Conscious sedation refers to a common technique which may be
used for a variety of diagnostic and therapeutic procedures such as
colonoscopy and gastroscopy. The advantage is that the patient
is able to cooperate and follow instructions while controlling
anxiety. Often, the patient may be given medication so that there is no
memory of the procedure.
For Hip surgery, on otherwise healthy patients, the best
combination
may be a Femoral nerve block, spinal anesthesia and with
intravenous
sedation. NOTE: The level of intravenous sedation can be varied
at
will throughout the procedure. This will not affect the level of
pain control.
This is why a number of surface hippies have reported “waking
up”
(light sedation) during their surgery. This is under the control
of
the anesthesiologist and doesn’t indicate a mistake.
When you go for pre-anesthesia assessment, ask questions and be
sure to answer fully and honestly so that the best procedure can be
planned.
Best to all,
Michael (MD in NC) (L) C+ 3/31/03 |
